10 - Fundamentals of Health Workflow Process Analysis and Redesign - Unit 8 - Quality Improvement Methods - Lecture A

Fundamentals of Health Workflow
Process Analysis and Redesign

Quality Improvement Methods
Lecture a
This material Comp10_Unit8a was developed by Duke University, funded by the Department of Health and Human Services,
Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024.
Learning Objectives
2
Upon successful completion of this Component the student is able to:

1. Describe strategies for quality improvement (Lectures a, b)
2. Describe the role of Leadership in Quality Improvement (Lectures
a, b)
3. Describe the local clinic improvement capabilities (Lecture b)
4. Describe and recommend tools for quality improvement (Lecture b)
5. Compare and contrast the quality improvement methodologies and
tools and their appropriate uses in the health care setting (Lecture
b)

Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign
Lecture a
Quality Improvement in the
Health Care Setting
Quality Improvement an approach to improvement of
service systems and processes through the routine use
of health and program data to meet patient and program
needs (Chang, 1999)

Examples of Quality Improvement Projects
Redesigning a Clinical Office
Reducing the time for patient intake
Redesigning the information flow in a laboratory
Increasing the access to care

3
Lecture a
Putting Quality Into Practice
The "Putting Quality Into Practice" video series
demonstrates the effects of workflow, resource and
systems reviews, electronic medical records (EMRs)
implementation and other quality improvement efforts on
a practice.
This series is an eight-part series that plays in a loop.
There is approximately 60 minutes of video. The series
was produced by the ABIM Foundation, a non-profit
foundation.
http://www.abimfoundation.org/Resource-
Center/Video/PQIP.aspx

4
Lecture a
Duke Databank for
Cardiovascular Disease
5
Lecture a
Images reprinted from http://digitaldukemed.mc.duke.edu/databank/Images/

Three Major Concepts
1. Quality is a Measurable Phenomenon
Six dimensions : Safe, effective, timely, patient-centered,
efficient, equitable
2. Safety
Errors are definable and measurable
The right plan is defined on the basis of professional
standards
To avoid errors, you must decide on the best plan in the
context of professional standards, and the plan must be
executed
3. Accountability
Measurable performance with consequences
Currently lies primarily with physicians
Physicians will increasingly be held accountable for
performance at the microsystem level

6
Lecture a
Quality Improvement
Knowing is not enough;
we must apply.

Willing is not enough;
we must do.

- Goethe
7
Lecture a
Focus
You have been introduced to concepts and practices
that will enable you to:
Identify and document the processes in a health care setting,
Collect and analyze information about processes in the health
care setting, and
Redesign the workflow processes and streamline this redesign
Quality Improvement methods and tools enable you to:
Collect and compile information on an ongoing basis,
Analyze the information for root causes,
Make decisions on how to eliminate these problems (process
improvement),
Change processes based on this analysis, and
Redesign (strategic change), and set timetable for these steps.

8
Lecture a
Quality Improvement in Health
Care Settings
In 2004 Stephen Shortell likened the U.S.
health care system to a shoddily constructed
building located in the pathway of an
impending natural disaster
Quality can be improved in the Health Care
Setting by understanding the Foundations
and Methods Quality Improvement.

9
Lecture a
Foundations of Quality
Improvement

Walter Shewhart
W. Edwards Deming
Joseph M. Juran

10
Lecture a
The PDSA cycle

Four steps:
Plan, Do, Study, Act

Also known as:
Shewhart cycle
Deming cycle
Learning and
improvement cycle

11
Lecture a
(wikimedia, 2010)
Summary Lecture a

12
Strategies for quality improvement (QI)
Need for aggressive QI in health care
Role of leadership in creating a culture
that supports QI
Lecture a
References Lecture a
References
Califf, R. M. (2006). Translating Clinical Trials into Practice (keynote). Tex Heart Inst J., 33(2), 192-196.
Chang, R. Y. (1999). Continuous Process Improvement (Rev ed.). San Francisco, CA: Jossey-Bass Pfeiffer.
Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Eds.). (2000). Institute Of Medicine: To Err is Human: Building a
Safer Health System. Washington, DC: National Academy Press.
Ransom, S. B., Joshi, M. S., & Nash, D. (Eds.). (2004). The Healthcare Quality Book: Vision, Strategy, and Tools (1
ed.). Chicago, IL: Health Administration Press.
The Duke Databank for Cardiovascular Disease - Overview. (n.d.). Retrieved February 9, 2012, from Duke Medical
Center Library & Archives website: http://digitaldukemed.mc.duke.edu/databank/overview.html

Images
Slide 5: Dr. Eugene A Stead, Jr. [photo]. Retrieved February 09, 2012 from:
http://digitaldukemed.mc.duke.edu/databank/Images/stead_eugene_thumbnail.jpg
Slide 5: Hardware Configuration [image]. Retrieved February 09, 2012 from:
http://digitaldukemed.mc.duke.edu/databank/Images/hardware_configuration_1971.jpg
Slide 11: DSP-user. (2010). Plan-Do-Check-Act Deming circle, Retrieved February 8, 2012, from
http://commons.wikimedia.org/wiki/File:Deming_PDCA_cycle.PNG

13
Lecture a

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